Cradle cap

Milk scab: description

Cradle cap generally occurs in babies for the first time at the age of three to six months. In some cases, the rash may develop earlier; However, eczema that is very early on is usually not milk scab, but a seborrhoeic dermatitis (head gneiss) or other skin diseases in the baby. If the cause of the eczema in the infant is not completely clear, it is called an eczema infantum. In the course of developing in babies with milk scab, however, typical symptoms of a beginning eczema (atopic eczema).

The term “milk scab” is somewhat misleading: the disease is unrelated to milk. Its name derives from the encrusted areas on the infant’s scalp and face, which are reminiscent of burnt milk.

Cradle cap as a symptom of atopic dermatitis

More than half of the children who later develop eczema show cradle cap as a first symptom. Sometimes, however, the first signs of atopic dermatitis also develop only at school age. About 10 to 15 percent of preschool children are at least temporarily affected by atopic eczema – making it one of the most common skin diseases in children with eczema. The number of children with cradle cap and atopic dermatitis has increased significantly in recent decades. For many, the disease heals over school, while in some it persists into adulthood. In Germany between 1.5 and 5 percent of adults suffer from atopic dermatitis.

Striking is the frequent combination of atopic dermatitis, hay fever (allergic rhinitis) and allergic asthma. These three diseases are also considered as atopic form circle together. It is not uncommon for cradle cap to enter the baby as the first harbinger from which other allergic diseases develop later. The atopic diseases can also occur individually.

Cradle cap: symptoms

Babies with cradle cap often develop typical symptoms: First, a reddish skin rash (Exanthem) on the child’s head, which may be accompanied by nodules and small blisters on the skin. Mostly the hairy scalp, forehead and cheeks are affected. At first small, dry scales from. As milk scab you call the yellowish to brown cruststhat form on the rash. In many infants eczema spreads to the arms, legs and torso. The diaper area is not affected in most cases.

Atopic dermatitis and milk scab cause a strong itching, In very young babies, this manifests first in frequent crying and very restless nights. As soon as the baby begins to scratch, the development of cradle cap intensifies. This also creates a portal of entry for bacteria, which often leads to larger sources of inflammation.

Cradle cap: causes and risk factors

The causes of cradle cap and atopic dermatitis have not yet been finally clarified; however, there are indications of both genetic predisposition and external risk factors. Physicians assume a multifactorial genesis, ie a disease development with several different causes.

The predisposition for atopic dermatitis and symptoms like milk scab is hereditary: It is passed on to the offspring via several different genes. If both parents suffer from atopic dermatitis, the child also suffers with a probability of 60 to 80 percent. However, not every child with a corresponding predisposition develops cradle cap and atopic dermatitis.

Rash, itching and cradle crusts in atopic dermatitis are caused by various complex processes in the skin. Usually there is a combination of three factors:

• Barrier disorders: Babies with cradle cap have a predisposition to dry skin. The upper skin layer (epidermis) loses more moisture than healthy infants; The skin is more permeable and can store less water. On the one hand, dry skin causes itching, on the other hand, it is also more susceptible to harmful influences and allergens.
• Immunological causes: Many people with atopic dermatitis have elevated levels of immunoglobulin E (IgE) in the blood. These are certain antibodies that play a major role in the development of allergies. For example, babies with milk scurf are often allergic to chicken eggs or cow’s milk. The defense reactions take place on the skin and lead to inflammatory processes.
• Neurovegetative causes: The nervous system is more sensitive to various external stimuli such as cold and dry climate, skin irritation (such as wool), but also psychological factors such as stress, sadness or anxiety. These factors increase the eczema in many people affected.

Milchschorf: examinations and diagnosis

The most important indication for the diagnosis of cradle cap and atopic dermatitis is provided by the complexion of the baby:

• red nodules and blisters
• yellowish milk scab crusts
• fine scaling of the skin
• characteristic areas where the eczema occurs (especially the face, scalp, arms and legs)

In addition, there are so-called in people with atopic dermatitis and other atopic diseases stigmata, These characteristics do not necessarily occur, are relatively common in children with cradle cap and eczema and facilitate the diagnosis. These include, for example, stronger lines on the palms and soles of the feet, a double lower eyelid crease (Dennie Morgan sign) and torn earlobes. In some neurodermatitis also the eyebrows to the sides are very thin (hertoghe sign), or the lips are more feared and quickly dry and cracked. Eczema on the fingertips and toes, which are sometimes confused with fungal infections, is also common in children.

In addition, to assess the likelihood of “baby cradle” behind eczema is a thorough one (Family) history important. This means that the doctor asks if the baby’s parents or siblings suffer from eczema or other atopic disease. Pre-existing illnesses and complications in the first months of life can also provide indications for the diagnosis.

Further investigations are usually not necessary for the diagnosis of milk scab and atopic dermatitis. In unclear cases, one can histological examination the skin exclude other skin diseases. At a blood test In many cases, elevated IgE levels can be found.

Milk scab: treatment

Whether you should remove cradle cap from the baby’s scalp and how to treat it, read the article Remove cradle cap?

Cradle cap: Disease course and prognosis

Cradle cap rarely occurs before the third month of life, but may last for several months to two years. Typically, the symptoms of atopic dermatitis shift during the course of the disease: After the first year of life, the eczema increases in cerebral and squat, neck and groin areas.

In some cases subsequently develops a chronic form of atopic dermatitis. In many children, however, it heals within the first two years of life, so that with the Cradle cap also the other symptoms subside.